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CVS PHARM > drugs for heart failure > Flashcards

drugs for heart failure Flashcards

1
Q

heart failure

A

heart is unable to pump sufficient blood to meet needs of body

  1. systolic dysfunction
  2. diastolic dysfunction
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2
Q

consequences of heart failure

A

heart failure
- dec CO
- inc in sympathetic activation and dec in bp
- dec renal blood flow
- inc renin, ang II, aldosterone
- inc Na+ and water retention
- oedema

OR

  • inc venous pressure
  • dec glomerular filtration rate
  • oedema
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3
Q

Name the drugs for HF treatment

A
  1. beta blockers
  2. sacubitril-valsasrtan
  3. hydralazine
  4. cardiac glycoside: digitalis
  5. diuretics
  6. ivabradine
  7. isosorbide dinitrate
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4
Q

beta blockers

A

B1 SELECTIVE
1. bisoprolol
2. metoprolol XL

NON SELECTIVE
1. carvediol

MIXED
2. nebivolol (low dose b selective; high dose non selective)

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5
Q

sacubitril- valsartan MOA

A
  • neprilysin inhibitor + AT1 blocker (ARNI)
  • inhibit BNP breakdown by neprilysin : prolonged BNP effects
  • inhibit ang II effects by blocking ang II receptors
  • natriuretic peptide system: activated under HF
  • brain natriuretic peptide BNP increases
  • BNP promotes vasodilation, natriuresis, diuresis
  • BNP antagonises RAAS (prevent vasoconstriction, decrease afterload)
    => favourable effects
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6
Q

Why is valsartan needed in combi with sacubitril?

A

sacrubitril inhibits neprilysin
neprilysin breaks down ang II
=> prolonged ang II effects
valsartan needed to block ang II effects

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7
Q

sacubitril-valsartan adverse effects

A
  • hypotension
  • hyperkalaemia
  • renal failiure
  • cough
  • angioedema
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8
Q

hydralazine MOA

A
  • direct arteriole vasodilator
  • inhibit IP3 calcium release from smooth muscle cells sacroplasmic reticulum
  • reduce peripheral resistance-> compensatory release of NA/A
  • inc venous return and CO
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9
Q

hydralazine clinical uses

A
  1. heart failure with reduced ejection (given w ISDN)
  2. 2nd line antihypertensive
  3. acute post partum HTN
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10
Q

hydralazine adverse effects

A
  1. flushing
  2. hypotension
  3. tachycardia

baroreflex associated sympathetic activation

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11
Q

hydralazine route of administration

A

IV: onset 5-30 min
oral: onset 20-30 min
7h half life

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12
Q

digitalis MOA

A
  • digitalis inhibit Na K ATPase exchange
  • increase [Na+] as it cannot exit cell
  • leads to decrease in Ca2+ efflux at the Na Ca exchange
  • increase intracellular Ca2+
  • increase systolic contraction
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13
Q

digitalis clinical use

A
  1. systolic dysfunction
  2. atrial fibrillation
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14
Q

digitalis adverse effects

A
  1. GI disturbance: nausea vomiting
  2. CNS: headache fatigue
  3. dysrhythmia: AF VF AV block
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15
Q

Name a commonly used digitalis

A

a type of cardiac glycoside

DIGOXIN

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16
Q

Digitalis toxicity treatment

A
  1. stop cardiac glycoside treatment
  2. antiarrythmatic drugs
  3. correction of magnesium and potassium deficiency
  4. digitalis antibody
17
Q

isosorbide mononitrate/ dinitrate moa

A

vasorelax-> arteriole and venous dilation -> dec in afterload and preload
-> CO and bp decreases-> therapy of CHF

18
Q

Loop diuretics (furosemide) MOA

A
  • inhibit Na+/K+/2Cl- transporter in the thick ascending limb of Loop of Henle
  • inhibit reabsorption of Na+, K+ Cl-, increase diuresis (urine production)
  • induce renal prostaglandin synthesis -> vasodilation, inc renal blood flow

very fast onset

19
Q

loop diuretics clinical uses

A
  1. oedema
  2. hyperkalemia
  3. acute renal failure
  4. anion overdose
20
Q

loop diuretics adverse effect

A
  1. hypokalemic metabolic alkalosis
    (dont use with aminoglyvoside)
  2. ototoxicity
  3. hyperuricemia
  4. hypomagnesemia
21
Q

potassium sparing diuretics MOA

A

promote diuresis without loss of K+
1. aldosterone receptor blockers decreased Na+ and H2O retention: spironolactone, eplerenone

  1. Na+ channel blockers, decrease reabsorption of Na+ hence excretion of K+: amiloride, triamterene

very slow onset

22
Q

potassium sparing diuretics clinical uses

A
  1. diuretic
  2. hyperaldosteronism
23
Q

potassium sparing diuretics adverse effects

A
  1. hyperkalemia
  2. acute renal failure
  3. metabolic acidosis
  4. kidney stones

CVS PHARM (6 decks)

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